AV fistula for IV access for sickle cell pt

Published

Specializes in floor to ICU.

Had a pt that had a 10yr old fistula inserted because she had no veins and gets frequent admissions for sickle cell crisis. It had a great bruit and thrill. Apparently, she had a PAC at one point that became infected with MRSA and after that one was removed she refused another. She had an AV fistula placed (made) instead.

Luckily, my charge nurse had accessed one before. We had to reaccess it because the cannula came out some and then got twisted. I pulled it and held pressure for about 10 min and then a bit later my charge nurse inserted an 18 gauge regular peripheral IV cath and we drew her labs, started IVFs and gave pain meds.

She wasn't from our area and was surprised by "all the drama" surrounding her having an AV fistula to use as IV access. Do you see this a lot in your area? Or ever seen it?

Up Vote Up Vote ×
Specializes in Hospital Education Coordinator.

never seen one used for that purpose. I can see the advantage of long term access but the big disadvantage is that many nurses are unfamiliar with access since dialysis nurses are the main ones who use them. Thanks for sharing.

Up Vote Up Vote ×
Specializes in Emergency Room.

i am shocked that a doctor would even consider that for a sickle cell pt. i have seen portacaths which makes more sense for a person with access issues but an av fistula is a little extreme in my book. i'm sure that the pt was informed that fistulas are used primarily for dialysis pts so the "drama" should not have been too surprising.

Up Vote Up Vote ×

I have seen fistula's on CF kids that have no access........many had tried ports and had problem after problem with them (blockages ++++).

It freaked me out at first but after several go's it was fine! We even designed a flow chart to hang in the tx room so that you could look at it as you were doing it!!!

Up Vote Up Vote ×
Specializes in ER/EHR Trainer.

We are not allowed to access fistulas in our ER, you must be HD certified.

I can't believe they performed that operation on a Sickler! A port I understand, a fistula?

Wow!

Up Vote Up Vote ×
We are not allowed to access fistulas in our ER, you must be HD certified.

Before accessing the fistula I would think some extra training and specific hospital policies should be in place. What if your charge nurse had not been there? I wouldn't want someone with no experience touching my fistula (if I had one).

If other posters are seeing this as a last resort chronic access, and this one has been inplace for 10 years, policies need to be written. Time to be proactive and be prepared.

Up Vote Up Vote ×
Specializes in Oncology.

I've used all kinds of central access working in oncology. I would have no idea what to do with an AV fistula. Even when I was on a renal floor for clinicals, we didn't touch their fistulas, they were just used in dialysis.

Up Vote Up Vote ×

I work as an Infusion Nurse in a vent/dialysis subacute/LTC and have seen AV fistulas for sicklers a few times before.

One thing I have noticed is that if they have not been on or are not on HD now...they soon will be.

I would say it is pretty rare to see one for IV access only however, she must have had some pretty awesome insurance or privately paid.

Up Vote Up Vote ×
Specializes in floor to ICU.
Before accessing the fistula I would think some extra training and specific hospital policies should be in place. What if your charge nurse had not been there? I wouldn't want someone with no experience touching my fistula (if I had one).

If other posters are seeing this as a last resort chronic access, and this one has been inplace for 10 years, policies need to be written. Time to be proactive and be prepared.

This is true! Very good point. I have been with my facility for 10 yrs (total 20 yrs experience) and this is the first.

Up Vote Up Vote ×
Specializes in Critical Care/Coronary Care Unit,.

I have never heard of that. She must be a really bad sickler for them to create a fistula. I thought only dialysis nurses could access an AV fistula or maybe in a really bad code situation if you're desperate. Guess there's a first time for everything.

Up Vote Up Vote ×

i had a patinet as part of clinical rotaion that was having one of these placed for frequent sickeling. had poor vein access due to numerous hospitlizations as a youth. seems this is rare to the point as even my ci was questioning my findings. here is a related study.

http://www.ncbi.nlm.nih.gov/pubmed/11967141

Up Vote Up Vote ×
+ Join the Discussion